In the previous blog entry, we took a quick look at the Emergency Wing of the conceptual floorplan. Today, I'd like to focus on the Acute Care/Swing Bed wing.
Acute Care is designated for patients who are admitted for short-term medical treatment of an illness or injury, while Swing Bed refers to the program which serves patients needing longer-term medical treatment of an illness or rehabilitation of an injury. Each of these services will be located in the conceptual Acute wing (above in the teal-ish blue color), as they are currently in the WMC facility.
The current WMC building actually has eight rooms designated for Acute Care. So why is there only four in the above conceptual, one may ask? Well, to put it simply - WMC rarely needs that many.
Looking at the 2017 usage, the average daily census for acute and swing was just 2.2 patients per day. So if we round up and take the average, five of the rooms are vacant throughout the year.
Sure, those numbers shoot up a bit in the summer months. As Wrangell's population increases with seasonal workers and visitors, so does the WMC traffic. July, Aug. and Sept. sees more than a 50% increase of inpatient/swing customers. Even during those months, we're averaging about 3.5 patients per day. For the most part, nine months out of the year, we could just about operate with a couple of acute rooms. Rarely do we ever see five or more patients.
So the solution for this concept design was simple - create enough patient rooms to serve the average number of patients, but prepare for the rare occasions when a surge in patients require additional beds. In the conceptual, each of the four designated rooms can be flexed to fit two patients.
One of the four rooms will be a negative pressure room, allowing ventilation in, but not out of the area. This is where any patients with airborne infections will be located and cared for.
Each room will feature a bathroom. No real news there, except that these bathrooms will be ADA compliant. A big step up from the current rooms, which are undersized with doors too small for wheelchair entrance.
I think the important facts to take away from this potential design are A.) the rooms will be larger, including the bathroom, and B.) they're not going to build above our current needs.
Just being new is going to be a massive upgrade. Not just because of the finishings and furnishings that will be included, but being up to code will provide more room to care for the patients. It will also leave more room for visitors, as friends and family are a part of the recovery process.
It's also important to understand that not designing above our current needs does not mean we're getting painted into a corner size-wise. Wold has been instructed to design with potential expansion in mind. In acute care's case, the wing can be extended West to easily fit four more rooms, as depicted in the photo below:
The entire conceptual presented during the Feasibility Update meetings allows for future expansion of the campus, if needed. Each area has room to expand out, as upward additions to include another level isn't cost effective. If Wrangell keeps growing, our data may show we need more rooms. Or if WMC proves to be an attractive spot for Swing Bed patients from all areas to heal up, the need for expansion could be there.
So if you read Wednesday's blog, you got a preview of the conceptual exterior design for the combined campus. Over the next couple weeks, I'd like to take you for a quick trip inside each portion of the possible campus design, starting with the section outlined below.
In Wold's conceptual design, this is where you'll find the Emergency and Acute Care wings, as well as the expanded laboratory and imaging departments. For blogging purposes, it's probably a better read when broken down further into those three sections, so let's start with Emergency, which can be found in the reddish tones.
Going back to the exterior conceptual, you'll see that there will be a drive-thru canopy to keep emergency patients and EMT's out of the elements. From that covered entrance, patients will enter to see Support areas on the left and right. Now would be a good time to explain these areas, as they appear throughout the concept designs.
These dedicated spots labeled 'Support' are merely placeholders, as Wold's Josh Ripplinger explained during the Feasibility Update presentation. When design gets past the concept phase, those support areas will be fleshed out to include offices, restrooms, storage, etc... Everything required to serve that wing, in addition to the dedicated rooms, will fall into the support areas. And again, this is a conceptual design, so some or all of these labels are fluid at the moment, so please don't fall in love with the potential layout just yet.
As you walk by the support areas towards the central Nurses Station, you'll see a Trauma room on the left and a pair of Treatment rooms on the right. The Trauma room will function like WMC's current ER, flexing to fit two patients if necessary. The main difference is that those patients who do not qualify as trauma patients, those just needing quick monitoring or treatment, can be directed to one of two private Treatment rooms. This layout would easily accommodate up to four patients will little flexing, whereas three patients are a tough fit given the current ER layout. Those Treatment rooms could also be flexed for other out-patient uses, such as infusion. All of this flexing keeps the square footage and price down.
You can tell from the conceptual that this was designed from the Nurses Station out. Lines of sight down all patient hallways, including the Long Term Care wing to the north, are shown with the red arrows. This maximizes effectiveness of WMC's current staffing model to better serve all patients.
One room that is not pictured yet is a dedicated EMT room. There will definitely be a room for our EMT crew in the building, Wold and SEARHC have assured us of that. Where it'll be located is still up in the air. Perhaps somewhere in one of the support areas in the image above, or in a support space adjacent to the Nurses Station, which would allow for successful hand-off of the patient and charting. Wherever it ends up, it was made clear to Wold that Wrangell really values our EMT's and they should have their own spot in the hospital to better serve us, and Wold listened.
So there's the first look at the Emergency wing conceptual floorplan. It's nowhere near a finished product, but you can see that Wold has done the legwork to give us more dedicated areas with flex capabilities, nurses within close proximity of the patients, and dedicated room for our EMT's. In the next blog entry, we'll zoom in on the Acute Care wing. Thanks for reading.
So the Legislature moved to not fully fund the Medicaid supplemental. In the state budget crisis, even the health of Alaskans isn't safe.
So hospitals are going to stop getting paid for a few weeks. Without burying the lead too much, the good news is WMC is going to be among a group of small hospitals that won't have payments stopped between now and the start of FY19 on July 1. This was news delivered by Margaret Brodie, Director of Alaska Dept. of Health and Social Services, to ASHNHA representatives last week in Anchorage.
While I'd like to tell you WMC is going to get paid because we're awesome or special, that's not it. The fact is, WMC is one of a handful of facilities across the state that does not possess the reserves to survive a six-week lapse in payments. WMC would be crippled if forced to scrape by without payments from our biggest revenue source. We would not be able to provide the level of care that our patients require.
In the end, each payment request from every hospital across the state will get paid. Most will just have to wait until July to see it. Thankfully, WMC will not have to wait until July. The sad fact is, the state is just going to be in the same situation next year. There was no increase of Medicaid in the FY19 budget. The Legislature went ahead and budgeted $30 million less than Gov. Walker requested for next year. On top of that, next year's budget is going to be short an additional $20 plus million to cover the back-pays they are just starting to accumulate.
It's scary to think that the state budget situation is having such an impact on healthcare. You know who doesn't have to sweat the state Medicaid budget? SEARHC. Their Medicaid payments come thru the Indian Health Service and are strictly federal, avoiding any sort of state funding. Yet another reason to root for SEARHC to assume hospital operations.
Conceptual Design is an early phase of the design process, where the broad outlines of function and form of something are articulated. It includes the design of interactions, experiences, processes and strategies. It involves an understanding of people's needs - and how to meet them with products, services, & processes. Common artifacts of conceptual design are concept sketches and models.
I preface this post by yet again stating that what has been presented thus far, in terms of the potential healthcare campus, are just concepts. In the beginning of each feasibility update, Wold's Josh Ripplinger informed those in attendance that "while what I'm presenting tonight may appear close to finished, it is far from a completed project." Given the info collected during visits to WMC and the AICS Clinic in April, and meetings with committees and staff, he was able to generate conceptual plans for the joint campus SEARHC is kicking the tires on.
That being said, I would like to present to you the first conceptual image of the exterior of the joint WMC/Clinic.
If you want to find your bearings, the far right portion of the above image is the existing AICS Clinic. The concept presented utilizes the current Clinic entrance as the main entrance for the entire facility. Logistically, Wold and SEARHC are still looking into any potential complications that may arise from a shared entrance, waiting area and check-in station, but are confident that with minor renovations, the space could serve the entire theoretical 44,500 sq foot campus.
Going from right to left, patients and staff could travel down two corridors into the hospital portion of the campus. The first areas you'd hit would potentially feature Physical Therapy, and the service areas of the campus (mechanical, I.T., laundry, etc...). Keep heading West and you'll pass the Imaging department on your left, which would no longer require CT to be housed in a trailer, and an expanded Laboratory area on your right.
The far left wing on the above image houses Emergency, Acute Care and Long Term Care (LTC). You'll notice the canopy on front of the Emergency area. Acute Care will feature four rooms, each capable housing two patients to meet rare surges in patients. LTC will feature larger, individual rooms, meaning no more roommates. There will also be more dedicated living areas for LTC, including separate activities and dining rooms, along with additional family areas.
We'll dive into the conceptual floorplan in the coming days. For now, I just wanted to give you a peek at what the exterior might look like. Below is an except from Josh's presentation, which shows what features Wold was looking to carry over from the Clinic in an attempt to make this look like it was designed as one building.
As far as the conceptuals go, I'd say Wold is successful in matching the addition with the existing. It also makes it easy to imagine what a finished product may look like.
I hope readers don't get their heart set on a particular design. I cannot state enough that these are just ideas on paper (or in this blog's case, digital). Changes will happen, whether that be on the design-end or the healthcare-end. How many changes and how dramatic? Only time will tell. It's just nice to see something. It makes it feel more real.
I'll be dissecting the feasibility update presentation and design concepts for the next few weeks. If you have any questions or comments, do not hesitate to contact me. I encourage you to share these posts on Facebook, or by whatever means you do your sharing.
Thanks to those who attended tonight's Feasibility Update at the Nolan Center. We weren't quite as packed as the Community Meeting back on April 9th, but that was expected. Sorry, but we couldn't get SEARHC to pony up more AK Air miles for a door prize.
What we were treated to was an update on the new hospital project, as well as some conceptual designs and potential floorplan configurations for the theoretical SEARHC healthcare campus. While I'd love to drop them all on you now, you'll have to wait until Wednesday as SEARHC and Wold representatives still have one more presentation on tap, which takes place tomorrow night in front of the Borough Assembly. Then, come Wednesday morning, I'll have some juicy conceptual info to share here on the blog.
I do want to reinforce that last sentence by saying again, the designs being presented are, in fact, concepts. Nothing is concrete, nothing is close to finalized. Everything is very much fluid and in the "can this be done?" phase. The main positive to take away at this time is that they came back, not only Wold, but SEARHC. It's still moving forward. And while SEARHC didn't offer up another envelope full of milage, perhaps they're one step closer to delivering a hospital.
Also, WMC is now on Instagram. If you're looking to for another outlet for happenings at WCA, or updates on the new hospital, follow us at instagram.com/wrgmedctr. Our social media widgets can always be found in the footer of all wrangellmedicalcenter.org pages.